POS0932 UPTAKE OF NEWER BIOLOGIC AND TARGETED SYNTHETIC DMARDs IN PSORIATIC ARTHRITIS, RESULTS FROM FOUR NORDIC BIOLOGIC REGISTRIES
Authors: B. Glintborg, D. DI Giuseppe, J. K. Wallman, D. Nordström, B. Gudbjornsson, M. L. Hetland, J. Askling, G. Gröndal, T. Sokka-Isler, S. Aarrestad Provan, U. Lindström
Journal: Annals of the Rheumatic Diseases (2022)

Background The treatment landscape in psoriatic arthritis (PsA) is changing, including newer biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) with different modes of action becoming available. However, the most effective treatment strategy in routine care remains to be established. Objectives To explore the uptake and treatment patterns of newer b/tsDMARDs, namely JAK-inhibitors (JAKi; baricitinib, tofacitinib, upadacitinib), IL-17-inhibitors (ixekizumab, secukinumab), abatacept, apremilast, and ustekinumab in PsA patients from the Nordic countries. Furthermore, to describe patient characteristics and extra-musculoskeletal manifestations at treatment start (=baseline). Methods Observational cohort study, using prospectively collected routine care data from 4 Nordic rheumatology registries. Treatments (newer b/tsDMARDs with tumor-necrosis-factor inhibitors (TNFi) as the reference) initiated from January 2009 until December 2020 and corresponding baseline patient characteristics were identified. Linkage to national patient registries was used to identify previous extra-musculoskeletal manifestations (0-5 years). Country-level data were pooled for analyses. Uptake of each drug was explored as the cumulative number of treatment starts (a) overall, irrespective of previous b/tsDMARD experience, and (b) in b/tsDMARD-naïve patients. Each patient could contribute &gt;1 treatment course. Results Overall, 13,364 unique patients contributing 24,325 treatment courses with either a newer b/tsDMARD (4,855, 20%) or a TNFi (19,470, 80%, whereof 10,897 were started year 2015-20) were identified. For the sub-group of 11,892 first b/tsDMARD treatment courses, 1,009 (8%) were a newer b/tsDMARD (10,883 were a TNFi, whereof 5,956 were started year 2015-20). Secukinumab dominated the newer b/tsDMARD uptake (1,848 new-starts, Figure 1). Ustekinumab-uptake increased over time both overall and in b/tsDMARD-naïve patients. In b/tsDMARD-naïve patients, apremilast had the fastest uptake (490 new-starts) (Figure 1). Use of JAKi was limited, especially in b/tsDMARD-naïve patients. Figure 1. Patients starting a newer b/tsDMARD tended to have longer disease duration and slightly higher disease activity at baseline (DAS28, patient-reported outcomes) than TNFi initiators (Table 1). Previous extra-musculoskeletal manifestations (uveitis, IBD) were rare, and with similar distributions across treatments (Table 1). Table 1. Baseline characteristics upon treatment start Abata-cept Apre-milast Bari-citinib Ixe-kizumab Secuki-numab Tofa-citinib Upada-citinib Uste-kinumab Any TNFi Cumulative uptake, n 362 935 106 342 1848 494 6 691 19470 Male gender, % 33 42 27 38 40 33 33 37 44 Age 54 (12) 53 (12) 55 (13) 52 (13) 51 (13) 54 (13) 52 (10) 50 (12) 49 (13) b/tsDMARD treatment number, % 1 9 52 9 11 14 9 0 20 56 2 19 15 12 26 25 18 17 19 25 ≥3 72 33 78 74 61 73 83 62 19 Disease duration, yrs 9 (8) 8 (8) 10 (8) 10 (8) 9 (9) 11 (10) 8 (8) 8 (9) 7 (8) Pain, VAS (0-100) 63 (21) 61 (23) 64 (23) 64 (25) 63 (24) 66 (23) 75 (17) 64 (23) 59 (24) DAS28 4.73 (1.34) 4.04 (1.35) 3.95 (1.36) 4.24 (1.19) 4.13 (1.36) 4.49 (1.33) 4.74 (0.88) 4.19 (1.32) 4.07 (1.29) Uveitis, %* 3 2 3 1 2 3 0 2 2 IBD, %* 1 1 3 1 1 1 - 3 1 Numbers are mean (SD) unless otherwise stated IBD: inflammatory bowel disease, bDMARD: biologic DMARD, ts: targeted synthetic *0-5 years previously, available all study period for Iceland, Sweden, Finland until 31Dec2018, not available for Denmark Conclusion In this cross-country collaboration we were able to explore uptake of newer b/tsDMARDs. TNFi still dominates compared to newer b/tsDMARDs in routine care treatment of PsA. Newer b/tsDMARDs are mainly used in patients with several previous treatment failures, i.e. with longer disease duration and higher disease activity, indicating difficult to treat disease. Further studies are planned to explore real-world treatment patterns and outcomes. Acknowledgements BG and DdiG contributed equally. Partly funded by NordForsk and Foreum grants. On behalf of the Danish DANBIO, Swedish SRQ, Norwegian NOR-DMARD, Finnish ROB-FIN and Icelandic ICEBIO registries Disclosure of Interests Bente Glintborg Grant/research support from: Pfizer, AbbVie, BMS, Daniela Di Giuseppe: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Dan Nordström: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Merete Lund Hetland Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Eli Lilly Denmark A/S, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopis, Sandoz, Novartis., Johan Askling Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB., Gerdur Gröndal: None declared, Tuulikki Sokka-Isler Grant/research support from: Abbvie, Amgen, BMS, Celgene, Eli Lilly, GSK, Medac, MSD, Novartis, Orion Pharma, Pfizer, Roche, Sandoz, UCB, Sella Aarrestad Provan: None declared, Ulf Lindström: None declared